The solution to a bankrupt health service is to create a specific payment for
the NHS and social care

Basically, the NHS is about to go bust. That’s the conclusion of a report by the King’s Fund into the state of health and social care in this country, published last week. The interim report was produced by a team chaired by Kate Barker, a former Bank of England economist, and has been published as all three main parties decide how to approach the issue of social care in their election manifestos. How we pay for the NHS and social care is set to be the major battleground.

One of the fund’s ideas is to start charging for GP and hospital visits: a suggestion that is occasionally trotted out as people try to find ways of increasing revenue for the NHS.

On one thing the authors and I can agree: the NHS is struggling financially. The £20 billion savings that it has to find by 2015 has meant budgets have been squeezed when the ageing population and increase in the drugs bill have placed intense pressure on services.

Earlier this year, board reports covering all 145 hospital trusts in England showed that 44 per cent expect to end the year in deficit - with a combined total of more than £330 million. A separate study of NHS foundation trusts in England found the number in serious financial trouble has nearly doubled in a year – from 21 to 39.

But the introduction of flat fees for accessing healthcare, while on the face of it an easy solution to the funding crisis, represents a dangerous slippery slope; further erosion of the “free at the point of access” principle that provides security for the most vulnerable and sickest members of society. A flat fee for seeing a doctor is bound to put off the most in-need people, while any attempts at means-testing will see bureaucracy rocket.

In addition, while the idea that the NHS cannot be sustained in its current form has gained widespread acceptance, this ignores the reality of the economics of healthcare.

The NHS is, as it stands, one of the cheapest delivery mechanisms in the world. It undoubtedly wastes money – as all healthcare systems do – and could be more patient-focused. But the fundamental principle on which it rests is the idea of nationwide risk-pooling – that the greater needs of one person are offset by the lesser needs of another. We all pay into the system knowing that we are unlikely to use the full extent of its services, but that this contribution will provide for those individuals who are sick and have a disproportionate call on those resources.

So, higher demand from one individual is offset by lower demand from another.

And it works. Insurance companies work on a similar principle, but because their cohort is smaller and they are concerned about profit margins, those with chronic diseases or requiring expensive treatments must either pay higher premiums or be excluded. A nationalised system is therefore egalitarian and just, as well as being the cheapest option.

All that the introduction of flat-rate fees to see a doctor would do is provide another source of revenue. In reality, it’s just another form of taxation, but because it’s not called that it’s more palatable to politicians.

The unwelcome truth is that there’s no choice here: the money is either going to come through direct charges for those that use services or through higher contributions from all of us. For the reasons already mentioned, I’d plump for the latter. But that means raising taxes, and that’s a brave political decision. (Currently, the NHS is largely funded from taxation with a small amount coming from National Insurance.)

I think the solution is to create a specific payment for the NHS and social care, in a similar way to how National Insurance was introduced in 1911 to provide a safety net for workers.

It would have to come with a cast-iron guarantee that the money was only used for the NHS and social care, and would only work if there were a corresponding drop in general taxation, to account for the new contribution being made.

Of course, people would still be giving the Government money, but I think most would not object to paying a tax that was ringfenced for the NHS. It would also help challenge the idea that the NHS was “free” by clearly showing everyone that we all pay for it.

And, perhaps, people would be less likely to miss appointments when they saw the NHS contribution leave their pay packet each month.

It will be good for children to go to school at two

Sir Michael Wilshaw, the head of Ofsted, wants children as young as two to start school. There has been a chorus of disapproval at his suggestion, with parents saying that it will further erode the magic of childhood and “undermine natural development”. I don’t buy this – this position is a luxury that ignores the thousands of children whose development is hampered by being brought up in impoverished surroundings. Only a third of children from low-income homes have reached what is considered a “good” level of development by the age of five. The achievement gap between those from disadvantaged backgrounds and those from more affluent families continues throughout their childhood into adulthood. By going to school at an earlier age, this inequality can be addressed.

The caveman’s diet is just a mammoth gimmick

According to research published in the European Journal of Clinical Nutrition, the “caveman diet” is twice as effective as some modern diets in helping people lose weight. The diet, which has a rash of well-known followers such as Uma Thurman (above) and Tom Jones, involves eating lots of berries, vegetables and lean meats such as chicken, but rice, pasta, dairy products and some bread are banned. It is supposed to mimic the diets of our ancestors before modern farming resulted in us eating increasingly processed and refined foods.

The study showed that women who adopted the Palaeolithic diet lost twice as much weight within six months as those who followed a modern programme based on official health guidelines.

I actually think the diet is pure marketing hype. It’s basically a framework for eating sensibly with a catchy name.

And before you try to source free-range woolly mammoth steaks from Waitrose, the study showed that after two years on the diet, the benefits tailed off. The researchers think that this was because people got bored with the regime and gave up.

It’s also worth pointing out that, despite getting plenty of exercise and eating healthy, free-range, organic food, the average life expectancy of a caveman is thought to have been around 40 years.

Perhaps not the best role models after all.

Max Pemberton’s latest book, 'The Doctor Will See You Now’, is published by Hodder. To order a copy, call Telegraph Books on 0844 871 1515